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  <td class=xl75 width=100 style='border-top:none;width:75pt'>　</td>
  <td class=xl75 width=129 style='border-top:none;width:97pt'>　</td>
  <td class=xl75 width=102 style='border-top:none;width:77pt'>　</td>
  <td class=xl76 width=102 style='border-top:none;width:77pt'>　</td>
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  <td class=xl75 width=112 style='border-top:none;width:84pt'>　</td>
  <td class=xl75 width=100 style='border-top:none;width:75pt'>　</td>
  <td class=xl75 width=129 style='border-top:none;width:97pt'>　</td>
  <td class=xl75 width=102 style='border-top:none;width:77pt'>　</td>
  <td class=xl76 width=102 style='border-top:none;width:77pt'>　</td>
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  <td height=93 style='height:69.95pt'></td>
  <td colspan=6 class=xl82 width=663 style='border-right:.5pt solid black;
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  <td class=xl73 width=118 style='width:89pt'>　</td>
  <td class=xl70 width=112 style='width:84pt'><span
  style='mso-spacerun:yes'>&nbsp;</span>主管单位负责人：</td>
  <td class=xl70 width=100 style='width:75pt'>　</td>
  <td class=xl72 width=129 style='width:97pt'>主管单位盖章：</td>
  <td class=xl70 width=102 style='width:77pt'>　</td>
  <td class=xl71 width=102 style='width:77pt'>　</td>
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  <td colspan=2 class=xl66 style='mso-ignore:colspan'></td>
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